关键词: 剖宫产术, 伤口愈合, 子宫, 瘢痕, 憩室, 治疗, 宫腔镜, 腹腔镜, 阴式手术

Abstract: Previous cesarean scar defect (PCSD) is one of the long-term complications after cesarean section, which can cause clinical manifestations of menstruation, infertility, cesarean scar pregnancy etc. The incidence rate of PCSD is increasing. The commonly used auxiliary examinations are transvaginal ultrasound and saline infusion sonohysterography. Minimally invasive surgerys are the main treatments, including hysteroscopy, laparoscopy and transvaginal surgery. Hysteroscopy is the most invasive surgery, it can remove the fibrotic scar tissue to facilitate menstrual blood drainage and perform fulguration of endometrial-like glands inside the scar to reduce irregular bleeding, it can also improve the endometrial environment conducive to pregnancy, but because of electrical injury and uterine perforation risk, it is suitable for patients whose residual muscle layer  thickness is more than 2 mm, the postoperative pregnant women need to be treated as the high risk population of uterine rupture. As for the patients whose residual muscle layer thickness is less than 2 mm, laparoscopic surgery or vaginal surgery should be adopted to remove the scar diverticulum and suture it again, which can improve the symptoms effectively.

Key words: Cesarean section, Wound healing, Uterus, Cicatrix, Diverticulum, Therapy, Hysteroscopes, Laparoscopes, Vaginal surgery